Student Registration Form

Student Registration Form

Please ensure you fill out the form in its entirety.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Student Expected Grade Level for Fall 2021*
Parent/Guardian Name*

First NameLast Name
Address*

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Email*

Confirmation Email
Phone Number*

Area CodePhone Number
Class Sessions

Sessions run from July 5, 2021 through July 29, 2021.
Class Sessions*

Session A: Mondays & Wednesdays 9AM-10AMSession B: Mondays & Wednesdays 10AM-11AMSession C: Mondays & Wednesdays 11AM - 12PM
Please note that your child can only be enrolled in one session. Select all sections that work with your schedule and we will notify you the session in which your child is enrolled.
Does your child have access to an electronic device and internet connection? At this time, all students must have access to an electronic device capable of video calling on platforms such as Zoom as well as internet connection.

YESNO
I allow tutors and teachers affiliated with YLI to instruct my child academically twice a week for the month of July 2021. All contact between the tutor and my child will take place in class, or through contact with the parent/guardian.*

YES, I allow.NO, I do not allow.
If you have any specific areas in which you know your child needs assistance in, list them below. Additionally, please note any information about your child that is pertinent to their learning experience.
Should be Empty:

Student Registration Form

Class Sessions